Pediatric Trauma
Pediatric Patients are NOT Aliens! They do, however, have different anatomy and physiology that must be considered - Sean M Fox MD
HWN Suggests
Multisystem Trauma in Children Part I: Airway, Chest Tubes, and Resuscitative Thoracotomy
Children are like Charlie Brown – large head, no neck, amorphous, underdeveloped and unprotected thorax and abdomen. Or, if you like, they’re like, apples – they have a large surface area and are easily internally bruised, often without overt signs of external bruising.
Chest tubes for children are very similar to the adult procedure – the traditional chest tube size is 4 x the child’s ETT size. Try to use smaller pigtail catheters, available in commercial kits, whenever possible. They’re easy, safe, and effective.
Resuscitative thoracotomy is for penetrating trauma with signs of life wthin 10-15 minutes of arrival. Find the correctable surgical cause of the arrest. Resuscitative…
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Pediatric Trauma Pitfalls
Shock can be challenging to recognize in a child. Children compensate very well! May not see hypotension until loss of >30% blood volume! Blood pressure may not be your best indicator! Look at Cap Refill!
Articles of Interest
Airway Management in the Pediatric Trauma Patient
To rapidly estimate DL blade size of the patient, remember “Miller 2 at 2 and 3 blade at third grade”. If you don’t have a length-based resuscitation tape, use this formulate for cuffed ET tube size: (Age/4) + 3.5 = cuffed endotracheal tube size. In an emergency situation a supraglottic device can be rapidly sized by comparing it to the auricle of the child.
An Evidence-Based Approach to Blunt Chest Trauma in Children
Prehospital delay of transport should be avoided as much as possible, especially if the delay is from repeated intravenous or intubation attempts. Emphasis should be placed on oxygenation, ventilation, treatment of tension pneumothorax, and motion restriction. Specific attention to oxygenation/ventilation is the first priority, and this can usually be accomplished with manual airway maneuvers; intubation is rarely required for pediatric patients.
Multisystem Trauma in Children Part II: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls
We should not allow children to become hypotensive – severe tachycardia alone should prompt us to resuscitate. In other words, permissive hypotension is not permissible for children. FAST is not sensitive enough to rule-out abdominal trauma.
